Secure pacemaker fixation critical for prevention of Twiddler's syndrome
✍ Scribed by Sarah A Zimmerman; Janice M Bright
- Book ID
- 104451066
- Publisher
- Elsevier Science
- Year
- 2004
- Tongue
- English
- Weight
- 577 KB
- Volume
- 6
- Category
- Article
- ISSN
- 1760-2734
No coin nor oath required. For personal study only.
✦ Synopsis
A two year old, female spayed border collie presented three weeks after permanent pacemaker implantation for weakness, lethargy and collapse. Electrocardiogram documented complete (3 rd degree) atrioventricular (AV) block, the absence of pacing and a ventricular escape rhythm. Thoracic radiographs revealed retraction and dislodgement of the passive fixation lead from the right ventricular apex. During a procedure to reposition the lead, it was noted that lead retraction had resulted from rotation of the generator with twisting and entanglement of the lead on itself and around the generator, a complication recognized in human patients as "Twiddler's syndrome". The pacemaker lead was removed, a new lead securely placed at the right ventricular apex, and the generator was secured into a revised subcutaneous pocket. Pacing was re-established and the Twiddler's syndrome has not reoccurred.